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Education of the ED Nurse Knowledgeable in every discipline: Pediatrics Obstetrics Medicine Cardiology Orthopedics Trauma Oncology Infectious disease Psychiatry Others
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Emergency Nursing, Education, and Legal Issues
Emergency Nursing Discuss the role of the emergency nurse in
community and patient education
Education of the ED NurseKnowledgeable in every discipline:
PediatricsObstetricsMedicineCardiologyOrthopedicsTrauma
OncologyInfectious
diseasePsychiatry Others
Knowledgeable in caring for all age groups:Newborns InfantsToddlersChildhood
Education of the ED Nurse
AdolescenceAdultGeriatric
Education of the ED NurseFacilitators of Learning in the ED
Nurse EducatorOrganizes and implements orientation
programsNurse ManagerPreceptorTeam LeaderCharge Nurse
Approaches to ED Nurse Orientation Review of EDs standards of care Check skills with return demonstration Preceptor-sponsored orientation Competency-based orientation
Organized system of assessing new ED nurses ability to perform proficiencies, tasks and ED skills
Essential components includeSkill and knowledge assessmentCompetence standards and critical
behaviors
Continuing ED Education Needed to promote
competence in nursing Enhance nurse’s working knowledge and environment Advances skills in education, research, theory Improves healthcare to the client Fosters personal and professional delopment
Beneficiaries of Education Nurse Employer
Increased competence Decreased liability Advanced expertise to benefit patient care
Profession Increased adherence to standards of practice Strengthened image of the nurse
Public Improved patient care
Obtaining Continuing Education Self-learning – Self-study Home study or correspondence Institution-sponsored CE Workshops, seminars Organizational meetings (ENA, AACN) Degree advancement Computer based instruction
Education of the ED Patient
Patient education: an ongoing process during the ED visit- information from the ED should change the patient’s knowledge, attitudes and skills
Education encompasses all disciplines of medicine
Information had to be customized to age and developmental level
Teaching should be adapted to culture and ethnicity
Education of the ED Patient “One-moment, one-visit” opportunity
Must be concise Immediately understandable Nurse must have information committed to memory
Opportunities for education Teaching begins at triage Before, during and after treatments Before and after medication administration Event specific education at discharge
Nurse’s role and responsibility Patient right to be education about disease process
or injury Education before and after procedure or
medication Nurse is legally responsible for teaching
content and is, therefore, open to potential litigation
Education – A Patient’s Right
Potential Obstacles to ED Education Lack of privacy Time constraints Effective nurse-patient rapport Deficiency in involvement of family of impaired
patient Opportunity to establish continuity and to follow
up for reinforcement and evaluation
Barriers to ED EducationPhysiological barriers: pain, restlessness,
age, prognosis, critical illnessPsychological barriers: intelligence, anxiety,
denial, depression, psychosisEnvironmental barriers: separation from
family, noise level, lack of sleepSociocultural barriers: language
barrier, ethnic background, lack of education
Illiteracy
Objectives Legal Issues Describe types of laws and legal
concepts of the emergency nurse Discuss the role of the emergency nurse
in patient transfer and legal issues
Consents Express consent
The voluntary consent of an individual seeking medical treatment
Implied consent Consent is implied when an individual is in a life- or limb-
threatening situation and is unable to provide express consent
Involuntary consent When the individual refuses to consent to needed
treatment, yet another individual (police, judge, physician) can ensure that the individual receives the treatment
Consents continued Informed consent
Three essential components presented to the patient/family by the physician before the procedure1. Describe the procedure to be performed2. Explain alternatives available3. Detail the risks of the procedure
Physicians have the responsibility to provide the information required
Consent DilemmasMinors
Minor may be allowed to consent to medical treatment if:Minor is emancipated- economically independent, married
True Emergency
Consent Dilemmas continued Refusal to consent based on religious conviction
Jehovah’s Witness – refusal of blood products Most states allow competent adults to refuse If the death of the adult would leave minor children
without a parent, the social policy consideration may override the patient’s wishes
If the patient is a minor and the parents are refusing medical care, it is necessary to involve hospital administration or legal council
Consent Dilemmas continued
Refusal of treatment-leaving AMA If a patient refuses treatment- ? patient’s
competency If found competent, ED physician must
explain risks involved in refusing treatment. This MUST be thoroughly documented
If the refusal puts life at risk, competency must be questioned – and MUST be documented
Consent Dilemmas continued
Patients in custody of law enforcement Consent for treatment remains with the
individual, not law enforcement personnel State law governs whether the individual
can refuse consent for withdrawal of blood or specimens when in custody
Transfer
Emergency Medical Treatment and Active Labor Act (EMTALA)
Considerations for Choosing Type Considerations for Choosing Type of Transportof Transport
Patient care requirementsPatient care requirements Patient’s response or contraindicationsPatient’s response or contraindications Out-of-hospital transit timeOut-of-hospital transit time Work space required vs. space availableWork space required vs. space available Personnel qualificationsPersonnel qualifications Weather conditions Weather conditions Terrain and/or road conditionsTerrain and/or road conditions
Stabilization & Preparation before Transport
ABCs with C-spine precautions
Splinting of injured extremities
Wound care Psychosocial
responses of patient Baseline diagnostic
studies Documentation to
accompany patient
Communication Before Before
transport:transport: Referring physician Referring physician
to receiving to receiving physician physician
Primary nurse to Primary nurse to receiving charge receiving charge nurse nurse
Referring/receiving Referring/receiving physician to physician to transport transport personnelpersonnel
Communication Communication (cont.)(cont.)
During transport: aa. Contact from vehicle or aircraft to sending Contact from vehicle or aircraft to sending
and/orand/or receiving facilityreceiving facility b. 3b. 3rdrd party relay if direct contact not possible party relay if direct contact not possible
After transport: a.a. Follow-up reportsFollow-up reports b. Auditsb. Audits c. Education and conferencesc. Education and conferences
Family Members and Friends
Crisis interventionNeed explanation of
condition and reason for transfer
Obtain consent for transferRemain at initial facility until
patient leavesNeed time with patient before
departureMaps and written directions
helpful
Recommended